Office Hours with Tidewater August Recap

For agent use only. This information is subject to change.

The August edition of Office Hours delivered exactly what agents need as we approach one of the busiest periods of the year – diving into industry trends, carrier updates, compliance reminders, Medicare changes, and preparation strategies for the upcoming Annual Enrollment Period (AEP).

Throughout the call, Ronnie James emphasized a central theme: the Medicare landscape continues to evolve rapidly, and successful agents will be those who stay informed, remain compliant, and focus on delivering long-term value to their clients.

Whether you joined us live or couldn’t make it, this recap includes everything you need to catch up and guide your success.

*As a Tidewater partner, you can also watch the Office Hours Call here.*

Main Points Covered

The main topics covered during August’s call include:

• Industry Pressures Across Medicare and ACA Markets
• Medicare Supplement Market Faces Challenges
• New Medicare Supplement Opportunities
• Compliance is More Important Than Ever
• New Realities for Medicare Advantage Carriers
• Humana Signals a Major Strategic Shift
• Changes to Food Cards and Chronic Benefits
• The Part D Premium Stabilization Demonstration Program Ends
• What Agents Should Be Doing Right Now

Industry Pressures Across Medicare and ACA Markets

While most of the conversation focused on Medicare, Ronnie opened by highlighting that pressures are affecting the entire health insurance market. ACA carriers have begun submitting bids for next year, and current projections indicate rate increases around 15%, driven by rising medical utilization and increasing prescription drug costs. These increases are expected to vary by state and county as carriers seek profitability.

On the other hand, agents serving in Alabama and Mississippi received encouraging news as Oscar Healthcare announced plans to expand into several new markets, including Jackson and Northern Mississippi, as well as Huntsville and Birmingham. Ronnie also shared that Oscar could be expanding into the Raleigh-Durham area of North Carolina.

*View extra resources and get contracted with Oscar Health ACA here.*

Medicare Supplement Market Faces Challenges

One of the most important discussions of the call centered on the growing pressures facing Medicare Supplement carriers. Ronnie shared a real-world example of an agent whose contract was terminated after a carrier determined she had written “too much high-risk business”, particularly individuals receiving dialysis treatment. The story served as a reminder that carriers are increasingly monitoring both agent performance and the overall health profile of submitted business.

Carriers are responding to rising loss ratios in several ways, including:

• Opening new blocks of business
• Increasing premiums significantly
• Tightening underwriting scrutiny
• Exiting difficult markets altogther

Examples include Wellabe and Physicians Mutual, which are transitioning many states to new business blocks. Ronnie noted that Plan G premiums for newly eligible Medicare beneficiaries have increased dramatically over the past few years, with some rates doubling compared to previous costs.

Additionally, Wellabe has announced its exit from California, Maryland, and Virginia, citing challenges associated with birthday-rule and anniversary-rule states where guaranteed rights have made profitability difficult.

New Medicare Supplement Opportunities

Despite market challenges, Ronnie highlighted emerging opportunities for agents willing to explore newer products. He discussed the expansion of Lumos, a newer Medicare Supplement carrier entering additional markets.

Ronnie gave his honest perspective, saying: newer products can offer stable rates during their early years due to regulatory flexibility, but they also come with less historical performance data than established carriers.

Overall, Ronnie thinks agents should focus on presenting factual information and helping clients make informed decisions rather than trying to predict future rate activity.

*Learn why agents are choosing Lumos Insurance and get contracted here.*

Compliance is More Important Than Ever

Ronnie explained that carriers are closely monitoring several things, including:

• CTMs (Complaints to Medicare)
• Rapid disenrollments
• SEP usage patterns
• Agent-specific enrollment activity

He specifically noted that carriers are increasingly scrutinizing Special Enrollment Periods (SEPs), especially those related to weather events, relocations, and disaster declarations. Agents who use these enrollments regularly should be prepared to show that qualifying circumstances were legitimate.

Agents need to be aware that compliance is not a secondary concern anymore. Carriers are constantly evaluating agent behavior and are willing to take action if they notice patterns that could negatively impact plan performance or star ratings.

New Realities for Medicare Advantage Carriers

Ronnie warned agents not to be surprised if additional plans become non-commissionable before AEP. In most cases, carriers are attempting to reduce rapid disenrollment and improve plan stability before making final decisions regarding future service areas and product offerings.

One example shared on the call involved Alignment Healthcare, which plans to make its PPO product non-commissionable while still keeping the plan available for 2027. According to Ronnie, carriers are recognizing that business generated by local agents tends to produce better outcomes than business generated through large call centers. Plans primarily dependent on call center enrollments usually experience more complaints and disenrollments, which can ultimately threaten star ratings.

Humana Signals a Major Strategic Shift

Ronnie described Humana as having experienced both substantial growth and substantial challenges.

Humana reported a second-quarter medical loss ratio of 91.2% and is expected to reduce membership by approximately 600,000 lives through market exits and plan changes. The company has already indicated that benefits will be less generous in 2027, with potential reductions in dental, OTC, and supplemental offerings.

Agents were encouraged to:

• Complete certifications as soon as possible
• Order marketing supplies early
• Pay attention to plan performance
• Prepare for possible client movement between Humana plans during AEP

Changes to Food Cards and Chronic Benefits

One of the most impactful updates for beneficiaries involves changes to SSBCI benefits, especially related to food cards and supplemental benefits for chronically ill members.

Beginning next year:

• Fewer medical conditions will qualify
• Self-attestation will no longer be allowed
• Physician verification will be required before benefits become active
• Some beneficiaries could temporarily lose benefits if verification is delayed

Ronnie specifically noted that Aetna has announced that high blood pressure will no longer qualify for SSBCI eligibility, potentially affecting a huge number of current recipients. Agents should be prepared to proactively educate clients about these changes and help them navigate verification requirements.

The Part D Premium Stabilization Demonstration Program Ends

The most anticipated topic of the call was the upcoming end of the Medicare Part D Premium Stabilization Demonstration Program.

Ronnie addressed misinformation that’s been circulating on social media, emphasizing that Medicare Part D is not being eliminated. Instead, a temporary demonstration subsidy designed to help carriers adjust to the Inflation Reduction Act is ending. It’s important to note that beneficiaries receiving LIS (Extra Help) benefits will not be affected by this change.

Key discussion takeaways include:

• The broader government subsidy supporting Part D remains in place
• Approximately 25% of beneficiaries may see little to no change
• Around 30% of beneficiaries may experience increases under $10 per month
• Other beneficiaries may see increases between $11 and $20 monthly

Ronnie stressed that formulary reviews and pharmacy network evaluations will become even more important during AEP as carriers look for additional cost-saving measures.

What Agents Should Be Doing Right Now

As September carrier rollouts approach, Ronnie encouraged agents to focus on the following priorities:

1. Complete all carrier certifications
   • You can find information and complete specific carrier certifications here.
2. Register for Tidewater’s upcoming AEP Roadshows
   • We’ll be hosting our Roadshows at seven locations! Make sure you save your seat here to hear from experts and gain the knowledge needed to get ahead of AEP.
     • Asheville, NC – August 18
     • Kannapolis, NC – August 25
     • Columbia, SC – August 25
     • Charleston, SC – August 26
     • Birmingham, AL – August 26
     • Raleigh, NC – August 27
     • Macon, GA – September 1
3. Review compliance training and SEP documentation
   • To avoid costly SEP enrollment mistakes, download our Medicare agent compliance guide.
4. Prepare clients for potential Medicare Advantage disruptions
5. Educate beneficiaries on upcoming Part D and SSBCI changes
6. Review Medicare Supplement pricing trends and carrier stability
7. Position yourself as a trusted advisor during significant market changes

Looking Ahead To What’s Next

August Office Hours reinforced a reality every Medicare professional is beginning to experience: stability has become harder to find across carriers, products, and regulations. Whether discussing Medicare Supplments, Medicare Advantage plans, food card eligibility, or Part D changes, the common theme was that agents need to have an adaptability mindset.

As you prepare for AEP, success will depend on staying informed, staying compliant, and guiding clients through complex decisions. The industry may be changing, but the need for knowledgeable advisors remains stronger than ever. As Ronnie reminded attendees, communities still need dedicated agents who are willing to educate, serve, and help clients navigate uncertainty with confidence.

We look forward to seeing you on our next Office Hours call in September, where we’ll continue preparing you for what’s ahead!